2930 MAPLE ST KAISER PERMANENTE 2021-11-15

SIM PERMIT APPLICATION' 111.1111 BUILDINOECHANICAL / PLUMBING / SIGN . PRINKLER / DEMOLITION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only;',Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS:2930 Maple Street, Everett,WA 98201 PROPERTY TAX#:00439069505800 LEGAL for new construction: Short Plat/subdivision __ _ Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: KAISER PERMANENTE(ATTN:Chad Mitchell) TENANT BUSINESS NAME(Commercial): KAISER PERMANENTE OWNER MAILING ADDRESS: STREET 1200 SW 27TH STREET crry RENTON STATE WA ZIP 98057 OWNER PHONE: 503-351-6302 OWNER EMAIL:Chad.J.Michell@kp.org CONTRACTOR NAME:MORTENSON CONSTRUCTION (ATTN: Holly Shoubridge) CONTRACTOR ADDRESS: STREET 10230 NE POINTS DRIVE, SUITE 300 CITY KIRKLAND STATE WA ZIP 98033 CONTRACTOR PHONE:425 497 7092 CONTRACTOR EMAIL:holly.shoubridge@mortenson.com CONTRACTOR LICENSE#(REQUIRED):CC MAMORC`190N6 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 021465 PRIMARY CONTACT: D OWNER 0 CONTRACTOR El OTHER(Please Specify) ARCHITECT CONTACT NAME: CONTACT PHONE:206-838-3260 Sangni Qu CONTACT EMAIL:sangni.qu@salus.archi BUILDING INFORMATION Existing Use of Building:MEDICAL OFFICE BUILDING Contract Price of Work: $60,000 Proposed Use of Building:MEDICAL OFFICE BUILDING Heat Source: ElGas DElectric ❑Other BUILDING USE: DSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure _ Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑✓T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Remodel existing conference room on Level 2 into a pulmonary function testing room. Scope includes removing existing entry door, filling in wall with 1-hour rated assembly, and providing new door and sink to the room. We will also remove existing carpet and replace with new resilient flooring. ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repsir Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) Forced Air Systems Other: Medical Gas Water Valves or Fixtures Gas Fireplace/InserULog Roof Drains Water Heater SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System No.of Heads Chemical Suppression System No.of Heads - ACKNOWLEDGEMENT:1 have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only 1 ry z--- PER y z. 1" , — DO i .1 n iazizozo /v"�V) Owner/Authori d Agent Signature Date (Revised 10/10/2018)